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1.
Eur J Clin Pharmacol ; 74(3): 349-356, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29198063

ABSTRACT

PURPOSE: Gamma-hydroxybutyrate (GHB) withdrawal is a life-threatening condition that does not always respond to standard treatment with benzodiazepines. Baclofen has potential utility as a pharmacological adjunct and anecdotal reports suggest that it is being used by drug users to self-manage GHB withdrawal symptoms. Here, we investigate current patterns of use and the online availably of baclofen. METHODS: Data triangulation techniques were applied to published scientific literature and publicly accessible Internet resources (grey literature) to assess the use of baclofen in GHB withdrawal. An Internet snapshot survey was performed to identify the availability of baclofen for online purchase and the compliance of retailers with the UK regulations. Data were collected according to pre-defined criteria. RESULTS: A total of 37 cases of baclofen use in GHB withdrawal were identified in the scientific literature, as well as 51 relevant discussion threads across eight Internet forums in the grey literature. Baclofen was available to purchase from 38 online pharmacies, of which only one conformed to the UK regulations. CONCLUSIONS: There is limited published evidence on the use of baclofen in GHB withdrawal, but both scientific and grey literature suggests clinical utility. Online pharmacies are readily offering prescription-only-medication without prescription and due to inadequate regulation, pose a danger to the public.


Subject(s)
Baclofen/therapeutic use , GABA-B Receptor Agonists/therapeutic use , Internet , Practice Patterns, Physicians' , Psychotropic Drugs/toxicity , Sodium Oxybate/toxicity , Substance Withdrawal Syndrome/drug therapy , Animals , Baclofen/economics , Baclofen/standards , Baclofen/supply & distribution , Biomedical Research/methods , Drug Trafficking/economics , GABA-B Receptor Agonists/economics , GABA-B Receptor Agonists/standards , GABA-B Receptor Agonists/supply & distribution , Humans , Internet/economics , Internet/ethics , Pharmaceutical Services, Online/economics , Pharmaceutical Services, Online/ethics , Pharmaceutical Services, Online/standards , Prescription Drugs/economics , Prescription Drugs/standards , Prescription Drugs/supply & distribution , Prescription Drugs/therapeutic use , Social Media/economics , Social Media/ethics , United Kingdom
2.
BMJ Open ; 5(6): e007517, 2015 Jun 30.
Article in English | MEDLINE | ID: mdl-26129634

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate changes in the uptake of intrathecal baclofen (ITB) following commissioning of this therapy by the National Health Service (NHS) England in April 2013. The specific objectives of this study were: (i) to explore the gap between the need for and the actual provision of ITB services; and (ii) to compare England figures with other European countries with comparable data available. SETTING: Data for ITB -related procedures were obtained from the Hospital Episode Statistics (HES) database from 2009/2010 to 2013/2014. PARTICIPANTS: Patients receiving ITB for the management of spasticity. RESULTS: The available data for implantation of ITB from 2009/2010 to 2013/2014 for the treatment of spasticity due to varied aetiologies show that there has not been an increase in uptake of this therapy. The estimated need for this treatment based on the incidence and prevalence of conditions susceptible to ITB therapy is between 4.6 and 5.7 per million population. Our analysis of the data available from the HES database showed that the actual number of implants is around 3.0 per million population. The same period 2009-2014 has seen an increase in the delivery of other neuromodulation techniques including spinal cord stimulation, deep brain stimulation and sacral nerve stimulation. CONCLUSIONS: There is a considerable gap between the need for and provision of ITB figures nationally. Additionally, within the same area, we have observed important differences in the ITB service delivery between the various trusts. The reasons for this can be multifactorial, including individual experience and opinions, organisational structures, resource and financial limitations. Further research analysing the efficacy and cost-effectiveness of this treatment in the UK might inform the development of Technology Appraisal Guidance for ITB, potentially leading to an improvement in service provision.


Subject(s)
Baclofen/administration & dosage , Muscle Relaxants, Central/administration & dosage , Muscle Spasticity/drug therapy , Baclofen/supply & distribution , Delivery of Health Care/statistics & numerical data , Drug Implants , England , Hospitalization/statistics & numerical data , Humans , Injections, Spinal/statistics & numerical data , Muscle Relaxants, Central/supply & distribution , Needs Assessment
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